Longitudinal history of mammographic breast density and breast cancer risk by familial risk, menopausal status, and initial mammographic density level in a high risk cohort: a nested case-control study.
Parisa Tehranifar, Erica J Lee Argov, Shweta Athilat, Yuyan Liao, Ying Wei, Alexandra J White, Katie M O'Brien, Dale P Sandler, Mary Beth Terry
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引用次数: 0
Abstract
Background: Elevated mammographic density is associated with increased breast cancer risk. However, the contribution of longitudinal changes in mammographic density to breast cancer risk beyond initial mammographic density levels, considering familial breast cancer risk and menopausal status, remains uncertain but holds important clinical implications.
Methods: In a nested case-control study within the Sister Study (323 cases, 899 controls; 12,095 mammograms), a cohort enriched for family history of breast cancer, we examined case-control status in relation to the largest annual change in percent density and dense area using mammograms available spanning 5.4 years, on average, using multivariable logistic regression and to the rate of mammographic density change using linear mixed-effects models. We considered effect modification by: mammographic density level of the earlier mammogram, the extent of family history, Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation (BOADICEA) risk strata, and menopausal status.
Results: Cases (diagnosed < 60 years) had greater initial percent density and dense area levels and a slower rate of decline in dense area than controls. Women with stable mammographic density (≤ 10% annual change) had an increased breast cancer risk as compared with women whose largest mammographic density change was > 10% annual decline (e.g., Odds Ratio (OR) 2.34, 95% Confidence Interval (CI) 1.63-3.37 for dense area). Increasing vs. decreasing dense area was also associated with elevated risk, especially in women with the highest dense area levels at the earlier mammogram (OR: 2.56, 95%CI 1.50-4.36). Although generally similar across menopausal and familial risk categories, the associations of MD change with risk appeared stronger in pre-menopausal and lower-risk women.
Conclusions: Women who maintain higher levels of mammographic density (i.e. do not decrease over time) or have increasing mammographic density over time have a higher risk of subsequent breast cancer than women with high mammographic density that decreases over time. These findings suggest potential for incorporating mammographic density trajectories in clinical risk assessment, and the importance of additional breast cancer monitoring in women not experiencing declines in mammographic density over time.
高风险队列中按家族风险、绝经状态和初始乳腺 X 线照相密度水平划分的乳腺 X 线照相密度纵向历史和乳腺癌风险:一项巢式病例对照研究。
背景:乳腺X线摄影密度升高与乳腺癌风险增加有关。然而,考虑到家族性乳腺癌风险和绝经状态,乳腺X线照相密度的纵向变化对乳腺癌风险的贡献超出了最初的乳腺X线照相密度水平,这一点仍不确定,但具有重要的临床意义:在姐妹研究(Sister Study)(323 例病例,899 例对照;12,095 张乳房 X 光照片)(一个富含乳腺癌家族史的队列)中进行的一项嵌套病例对照研究中,我们使用多变量逻辑回归分析了病例对照状态与平均 5.4 年乳房 X 光照片密度百分比和致密区域最大年度变化的关系,并使用线性混合效应模型分析了乳房 X 光照片密度变化率的关系。我们考虑了以下因素对效果的影响:早期乳房 X 线照片的乳腺密度水平、家族史程度、乳腺和卵巢疾病发病率分析及载体估计(BOADICEA)风险分层以及绝经状态:病例(确诊病例数每年下降 10%(例如,致密区的患病率比(OR)为 2.34,95% 置信区间(CI)为 1.63-3.37)。致密区增大与缩小也与风险升高有关,尤其是在早期乳房 X 光检查中致密区水平最高的妇女(OR:2.56,95%CI 1.50-4.36)。虽然绝经期和家族风险类别的情况基本相似,但绝经前和低风险妇女的MD变化与风险的关联性似乎更强:结论:乳腺X线摄影密度保持较高水平(即不随时间推移而降低)或随时间推移乳腺X线摄影密度不断增加的妇女,其罹患乳腺癌的风险高于乳腺X线摄影密度较高但随时间推移而降低的妇女。这些研究结果表明,将乳腺X线照相密度轨迹纳入临床风险评估是有潜力的,而且对于乳腺X线照相密度没有随时间推移而下降的妇女,进行额外的乳腺癌监测也很重要。
期刊介绍:
Breast Cancer Research, an international, peer-reviewed online journal, publishes original research, reviews, editorials, and reports. It features open-access research articles of exceptional interest across all areas of biology and medicine relevant to breast cancer. This includes normal mammary gland biology, with a special emphasis on the genetic, biochemical, and cellular basis of breast cancer. In addition to basic research, the journal covers preclinical, translational, and clinical studies with a biological basis, including Phase I and Phase II trials.